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Validation of ACCESS: an automated tool to support self-management of COPD exacerbations.

Boer, L.M., Heijden, M. van der, Kuijk, N.M. van, Lucas, P.J., Vercoulen, J.H., Assendelft, W.J.J., Bischoff, E.W., Schermer, T.R. Validation of ACCESS: an automated tool to support self-management of COPD exacerbations. International Journal of Chronic Obstructive Pulmonary Disease: 2018, 13, 3255-3267
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Background
To support patients with COPD in their self-management of symptom worsening, we developed Adaptive Computerized COPD Exacerbation Self-management Support (ACCESS), an innovative software application that provides automated treatment advice without the interference of a health care professional. Exacerbation detection is based on 12 symptomrelated yes-or-no questions and the measurement of peripheral capillary oxygen saturation (SpO2 ), forced expiratory volume in one second (FEV1 ), and body temperature. Automated treatment advice is based on a decision model built by clinical expert panel opinion and Bayesian network modeling. The current paper describes the validity of ACCESS.

Methods
We performed secondary analyses on data from a 3-month prospective observational study in which patients with COPD registered respiratory symptoms daily on diary cards and measured SpO2 , FEV1, and body temperature. We examined the validity of the most important treatment advice of ACCESS, ie, to contact the health care professional, against symptom- and event-based exacerbations.

Results
Fifty-four patients completed 2,928 diary cards. One or more of the different pieces of ACCESS advice were provided in 71.7% of all cases. We identified 115 symptom-based exacerbations. Cross-tabulation showed a sensitivity of 97.4% (95% CI 92.0–99.3), specificity of 65.6% (95% CI 63.5–67.6), and positive and negative predictive value of 13.4% (95% CI 11.2–15.9) and 99.8% (95% CI 99.3–99.9), respectively, for ACCESS’ advice to contact a health care professional in case of an exacerbation.

Conclusion
In many cases (71.7%), ACCESS gave at least one self-management advice to lower symptom burden, showing that ACCES provides self-management support for both dayto-day symptom variations and exacerbations. High sensitivity shows that if there is an exacerbation, ACCESS will advise patients to contact a health care professional. The high negative predictive value leads us to conclude that when ACCES does not provide the advice to contact a health care professional, the risk of an exacerbation is very low. Thus, ACCESS can safely be used in patients with COPD to support self-management in case of an exacerbation. (aut. ref.)